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General NPI Number Information
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NPI Number | 1457078784
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Entity Type | Organization
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Legal Business Name | IL DIAGNOSTICS CORP
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 1580 N NORTHWEST HWY STE 6
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City | PARK RIDGE
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State | IL
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Zip | 60068-1464
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Country | US
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Telephone | 872-946-7074
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 N NORTHWEST HWY STE 6
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City | PARK RIDGE
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State | IL
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Zip | 60068-1464
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Country | US
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Telephone | 844-417-0903
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMED A KHALIDI
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Credential |
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Telephone | 844-417-0903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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